How to Prevent Knee Pain When Running
What is “Runner’s Knee” ?
Knee pain is the most common lower extremity injury during running and up to 90% of runners will experience knee pain at some point. The knee joint has multiple structures that can be irritated with running, but most commonly “Runner’s Knee” is caused by pain on the underside of the patella or kneecap. The knee joint includes the femur, tibia, fibula, and patella boney articulations. “Runner’s Knee”, sometimes called Patellofemoral pain, occurs when too much force is being put on the kneecap and the cartilage under the kneecap is irritated. The pain under the kneecap can be a dull ache or a sharp pain with every step when really inflamed. Typically runners feel pain around the kneecap and feel pain when running long distances, sitting for long periods, squatting, and going down steps. The knee cap pain will feel better with rest, and avoiding pressure through the knee. Females are more likely to suffer from “Runner’s Knee” compared to males who run the same distance. Many people who have seen an orthopedic surgeon have heard that running will give you arthritis. Unfortunately, orthopedists only work with runners who have knee pain so they have a selection bias toward runners which is inaccurate. There are multiple research studies showing that runners has LESS incidence of knee and hip osteoarthritis as you age.
What causes knee pain from running?
Running is a complicated skill that puts more force through joints than walking alone. When the force in the knee joint exceeds a certain amount, the cartilage on the underside of the kneecap will become irritated. There are many factors that determine how much force goes through the knee including running technique, choice of shoes, and muscular strength. Despite being a complicated skill, most runners have never given thought to how they run, they just lace up their shoes and take off. Research has shown that the more miles you run, the higher likelihood you have of experiencing knee pain while running. The most common causes of knee pain I see in the clinic are overstriding/heel striking, poor hip/pelvis strength, and hip flexor/quad muscle tightness.
How to prevent knee pain while running?
Currently, most runners will treat their knee pain with rest and ice and hope it goes away by the next time they go for a run. They will back off their mileage and hope that time will fix their knee issue. While this strategy can work for some mild cases of "Runner’s Knee”, many people experience knee pain when they go back. This frustration with not being able to run causes many to stop running. The main factor in treating and preventing Runner’s Knee is distributing the force into the kneecap. There are many ways that runners can take the load off their knees to get back to the mileage they want, here are the top ways I’ve helped runners get rid of Runner’s Knee for good.
1. Improve Hip Flexor and Quadriceps Mobility
Americans spend on average 13 hours per day sitting, and sitting for long periods of time causes the front of the hip to shorten leading to tightness in the hip flexor and quadricep muscles. Chronic tightness in the front hip and knee muscles increases the downward force on the kneecap which can lead to Runner’s Knee. Stretching and foam rolling are the most efficient ways to improve hip flexor and quadriceps tightness and mobility.
Most importantly, we need 1-2 minutes to let the brain decrease the muscle tone and make short-term changes in the muscle.
Stretching and Foam Rolling can both significantly improve knee pain with running. Some runners have a preference, but it depends on which one feels better after 1-2 minutes.
2. Improve Hip Strength
Another adverse effect of sitting during the day is the inefficient use of our gluteal muscles. The gluteal muscles are the largest muscles in the body and when trained properly, can lessen the load on the knee. Strong and stable hips lead to strong knees by helping distribute the forces of running. The easiest way to improve the strength of the gluteal muscles is with bodyweight exercises including bridges, planks, side planks, bird dogs, and hip abduction raises.
There are numerous ways to build strength in the outer hip muscles but a good place for runners to start is the Modified Side Plank- leg raises.
If you want more details, you can also check out our BEST Strengthen Exercises for Runners.
3. Increase Running Cadence
Running technique is the most significant way to decrease the loading on the knee to prevent or improve an injury. A simple way to improve technique is the increase the number of steps taken. While this may seem counterintuitive to take more steps, this will prevent a poor foot strike position and set your body in a good position to fall forward rather than absorb the force. More steps also help distribute the force going into the knee with each step. Less steps equal more force going into the foot, knee, and hips.
The gold standard for running performance and efficiency is a running cadence of 180 steps per minute. If you don’t know your cadence, set a timer for 10 seconds, count your steps, and multiply by 6. You don’t have to be at 180 steps per minute to help, increasing running cadence of 5-10% has been shown to significantly improve running technique.
If you are reading this and are frustrated that your knee pain is keeping you from running, we can help. You’ve likely gone to the doctor or orthopedics office and been told to stop running and everything will be fine. Unfortunately, stopping the thing that helps you physically and mentally is not the answer. We know there is a better way and helped hundreds of runners return to running pain-free.
If that sounds like you, set up a Free Strategy Call so we can determine what you need to help and put a plan together a plan to resolve your issue for good.
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Dr. Ryan
